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Tools may help identify young women who should receive bone mineral density tests

SAN DIEGO – There is no consensus on what risk factors should be used to determine which younger women at risk for osteoporosis should receive bone mineral density tests, according to a presenter at the ACP Internal Medicine Annual Meeting.

“Many of these lists [of risk factors] are rather long,” Kristine E. Ensrud, MD, MPH, FACP, professor, department of medicine and division of epidemiology, University of Minnesota, said during her presentation. “For a busy clinician in a primary care setting, the default in many instances will be to simply order the test.”

Ensrud discussed some available tools that may help physicians decide when to order bone mineral density tests for younger women.

The Osteoporosis Self-Assessment Tool, or OST, uses age and weight to calculate those at risk for low bone mineral density. A score of less than two is proposed as a cutoff to select younger, postmenopausal women for bone mineral density screening, according to Ensrud.

Another tool she referenced was the Fracture Risk Assessment Tool, or FRAX, which uses age, sex, weight, height, personal and parental history of fractured hip, femoral neck bone mineral density, as well as smoking, glucocorticoid, rheumatoid arthritis, secondary osteoporosis and drinking status to predict an individual’s risk for fracture. According to Ensrud, women aged 50 to 64 years who have 10-year absolute probability of major osteoporotic fracture of 9.3% or higher as determined by this tool, should get a bone mineral density test.

Ensrud referenced a study that compared these tools among women aged 50 to 64 that found that OST had a sensitivity of 79, a specificity of 70, a positive predictive value of 15 and an area under the curve of 0.75. FRAX had sensitivity of 33, specificity of 86, positive predictive value of 14 and area under the curve of 0.6 when leading to the identification of osteoporosis (All scores had a CI of 95%.)

“Complex risk assessment tools do not perform any better than simple tools in selecting younger, postmenopausal women for [bone mineral density] testing. Despite accelerated rates of bone loss associated with menopause the absolute fracture probability is low, thus ‘need a baseline’ is not a strong rationale for ordering a [bone mineral density] test in a younger, post-menopausal woman,” Ensrud said. “A reasonable strategy, based on current evidence, is that if you discuss it with your patient, and you’ve decided that drug treatment will be initiated for a T-score of –2.5 or less, I would consider using OST to determine if [bone mineral density] testing is warranted.” – by Janel Miller

References:

American College of Rheumatology’s FRAX Risk Assessment Tool Web Page (accessed on 04-02-17)

Ensrud, KE. Session MTP 091. “Osteoporosis: Can We Keep It Simple?” Presented at: ACP Internal Medicine Meeting; March 29-April 1, 2017; San Diego.

University of Sheffield's Fracture Risk Assessment Tool Web Page (accessed on 04-02-17)

Disclosure: Ensrud reports receiving consulting fees from Merck, Sharpe and Dohme.